Decision time for Md.'s health exchange [Editorial]

Since Gov. Martin O'Malley declared that the state's health insurance exchange website was functional for most users, anecdotal reports have been mixed. Some people report continued problems with frozen screens and other glitches that have bedeviled the site; others say they were finally able to enroll with relative ease. The preliminary numbers of new enrollments, though, suggest some genuine improvement. Monday saw about 1,100 enrollments, nearly 50 percent more than the site's best day before the fixes went into place. Some of that is doubtless because, with a looming deadline to enroll in coverage that starts Jan. 1, those who have been shopping for policies have finally made their selections. But improvements to the website must also play a role.

That said, the pace of enrollments is still far too low. If the exchange is able to replicate its best weekday and weekend performance during every one of the 104 days between now and the end of the open enrollment period on March 31, Maryland will still only achieve about three-quarters of its goal of signing up 150,000 people with private coverage. The site may be better, but better isn’t good enough.

Under those circumstances, the question raised by Rep. John Delaney, a Montgomery County Democrat, about whether it would be better for Maryland to scrap its effort to build its own exchange and instead join the federal one has merit. Indeed, Gov. Martin O'Malley acknowledged on Monday that the option — and all others — remain on the table.

That's a hard possibility for Governor O'Malley to acknowledge. Under his leadership, Maryland was one of the most aggressive states in the effort to build out its own exchange — a strategic decision that appears in retrospect to have involved no small amount of hubris and political ambition. Walking away now from all that effort and tens of millions in expenditures would be particularly embarrassing.

It would also have policy implications. Maryland decided to build the kind of exchange it did because officials wanted to create something of a one-stop portal that would integrate shopping for private plans and enrolling in Medicaid. Theoretically, that would make the system much easier to navigate for families in which, for example, the children are eligible for Medicaid and the parents for private plans. The state also had designs on eventually integrating enrollment for other social services — like food stamps and energy assistance — into one system. Scrapping the state exchange altogether would ensure that none of that would be possible, at least not anytime soon.

Of course, the very complexity those aspirations entailed may be partly to blame for the troubles Maryland's site has had. Other states that adopted more bare-bones approaches have experienced far fewer problems, and even the federal exchange is now working relatively well. Mr. Delaney's question gets to one of the key issues: Knowing what we know now, should we conclude that such ambitious features are simply unfeasible and cut our losses? But it also raises another: Are we now at a point where the disruption of switching to the federal exchange would be greater than that of working through the current system?

To that end, perhaps the most heartening development for Maryland's exchange in the last week was the hiring by the O'Malley administration of Columbia-based Optum/QSSI, the technology firm that is credited with doing much of the work to fix the federal exchange. For that reason, the company is uniquely qualified to evaluate whether all or part of the work being done by the state's website could be better accomplished by joining the federal exchange. Optum/QSSI is being empowered to essentially ride herd over the other contractors working on the site and to provide a fresh set of eyes about what can and cannot be salvaged, and whether the software the state bought is up to the task in general. The decision to switch to the federal exchange is not a binary one; the state could switch some functions to the federal site but not others, and could do so temporarily while the state site is being fixed.

Both the governor and Lt. Gov. Anthony G. Brown indicated on Monday that they are open to all options. They need to be. We can't let pride or momentum get in the way of doing whatever it takes to make sure Maryland residents can sign up for health insurance as soon as possible. After all, despite the political overtones, that's what this is about.

Correction: An earlier version of this article provided an incorrect date for the end of the open enrollment period for coverage under the Affordable Care Act. The deadline is March 31.

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